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Home Our Missions Mission of Charity The Difficulty of Childbearing in the Land Below the Wind

The Difficulty of Childbearing in the Land Below the Wind

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Pitas is the poorest county in Sabah, Malaysia. Its aboriginal villages are deep inside the tropical rainforests and are not easily accessible by cars or boats. Unfortunately, the mortality rates of newborn babies and women in childbirth in the local aboriginal villages were once the highest in Malaysia. Pregnant women had to go down the mountains to seek safer deliveries of their babies. But to do that, they had to journey for several hours or even two days through the rainforest, across rivers, mountain roads, and grass plains while carrying a torch and a bag of clothes. What they feared most was going into labor when they were in the middle of nowhere. Local Tzu Chi volunteers decided to do something to reverse this dreadful situation.

"The Land Below the Wind"
Sabah State, in eastern Malaysia, has a land area of 72,500 square kilometers, about twice the size of the state of Maryland, but with only two million people. It is bounded on the west by the South China Sea, and on the east by the Sulu Sea and Celebes Sea. To the northeast lie the Philippines, which are often ravaged severely by typhoons. In Sabah, however, there are no typhoons or earthquakes, so it is called, "The Land Below the Wind."

Thirty-two different ethnic groups are scattered throughout the land. Some support themselves by collecting latex from rubber trees, others lead a nomadic lifestyle of hunting and gathering. Without a permanent residence and with only a limited harvest, these people lead a rather rough life. Temperatures range between 26 and 30℃ (79--86℉) all year round. Traditional long houses are built with trees. The women of the Rungus tribe wear heavy bronze rings on their hands and earlobes as part of their traditional dress.

Mount Gunung Kinabalu is 4,001 meters tall. The lushly tropical rainforests, animals, plants, the blue sky, the white clouds, and the various indigenous cultures attract people from around the world to visit this valuable natural habitat.

Our cars zigzagged down the winding mountainous road. To one side was vast green land spreading to the horizon. With its natural beauty Sabah seems like a paradise to visitors, but the land has not brought prosperity to the people who live there. The aborigines, who regard Mount Gunung Kinabalu as their spiritual symbol, have led difficult lives for generations.

In November 2006, local Tzu Chi volunteers took us to visit the aborigines in Pitas, the poorest county in Sabah. "Pitas" means "cut off" in the aboriginal language. The high mountains, rivers and winding mountainous roads indeed cut off any connection between the natives and modern society. The nomadic agricultural lifestyle and over 80 dialects of the inhabitants further impede communication with modern civilization. Pitas is about a three-and-a-half hour drive from Kota Kinabalu, the capital, but the medical standards in Pitas are 20 years behind those of the city!

Pitas has a population of 20,000, but there is no hospital; there are only 12 small clinics with a few nurses and one doctor rotating among them. Faridah Bt. Md. Yakub, a senior nurse who has worked in Pitas for nine years, told us that the villages have no doctors, so in case of an emergency the nurses themselves need to fill that role.

The poverty, inconvenient transportation, and lack of medical care in Pitas were the reasons that pregnant women there used to have the highest mortality rate in Malaysia.

Yakub said with a frown that in the past she didn't understand why local women were always late for their prenatal tests. She now understands that the tribes are off the beaten track with poor transportation, so the aboriginal women, with their enlarged bellies, have to take boats, cross bridges, and walk for hours or even two days to reach a clinic. Some women choose to deliver their babies at home because they have no money for transportation down the mountains. A simple, sharpened piece of bamboo is the tool for cutting the umbilical cord. The mortality rate for childbirth is still very high.

Kampong Lok Dangkaan is a village located to the north of Pitas. A woman there had recently died in childbirth, so we went to visit it with Yakub and another nurse, Sahadiah Sulai.

After driving for an hour, we stayed overnight in Telaga. The next morning we took two boats, and an hour later we arrived at a sandy beach near the village. We took off our shoes before we jumped into the water and waded to the beach.

The village was very beautiful with coconut trees along the beach, and a blue sky and white clouds above. About a hundred families of the Bajau-speaking Ubian tribe from the Philippines lived here. They caught fish for a living.

The house of the woman who had died stood by the sea, and her neighbors welcomed us at her door. We climbed up the ladder and entered the stilt house, typical in that tropical area. There leaning shyly against their grandparents were twin girls who had lost their mother. Sulai, who often came here to care for pregnant women, told us that it was rainy on the evening of March 18, 2002, and the twin girls* mother was in bad shape. She suffered from serious anemia and had a premature delivery. Sulai and others took her to the hospital in the rain, but her uterus bled seriously after the surgery. She died on the way to a major hospital in Kota Kinabalu.

The best transportation out for villagers was by boat, and it was the same for pregnant women wanting to go to the clinics. Sulai said helplessly, "Whey need to do so even in an emergency and bad weather. When it rains, the women are covered by a canvas."

It was sunny when we went to visit. Even with lifejackets on, we were still frightened by the rocking of the boat on the sea, and the splashing seawater got us wet. Thus, we could imagine the torment these pregnant women had to endure when they had to take the boat to the other shore with their enlarged bellies, especially when they were having their labor pains at the same time.

The neighbors surrounded us and told us their stories. Norhaya Asang, 27, said on the day when she had to give birth, she refused to go on the boat when she saw the wind and rain on the sea. Her mother-in-law helped her deliver the baby at home. Fortunately, her child was born safely. Now two years old, he is her fourth child.

In the village, it is very common for neighbors to help each other deliver babies. Less than 50 meters (165 feet) from Asang's house lived Katombangan Tinti Lahan, who has helped deliver over 100 babies. Lahan, 70, held a piece of bamboo and a small rope and explained to us how she severed the umbilical cords. We were informed that the twin girls' mother was her niece. Although Lahan is well known for her skills, it was sad that she still could not save her niece.

Women who have anemia, hypertension, or more than five children are all considered to be in the high-risk group, but unfortunately many women in Pitas belong to this group. Concerning these women, the nurses feel the most helpless. "We can only ask these women to come down the mountains earlier for childbirth and not wait until the last minute," said Yakub.

A simple expectation like this is rather difficult to achieve, however. Yakub had once arranged for a pregnant woman who had received regular prenatal tests to go to a clinic in Kota Marudu to deliver her child, but the woman was sent home because the clinic had no space available to accommodate her. Yakub later found out that the woman had died in childbirth, and that depressed her very much.

Pregnant women in Pitas cannot stay in the clinics before they are due and wait for their deliveries because there is no room for non-patients. If they cannot find a place in town to stay, they must trek back home again across the mountains and rivers. The trips are a tough challenge for pregnant women, and their fates are ruthlessly enforced by heaven.

A serious drought in northern Sabah from mid-1997 to mid-1998 reduced harvests and caused food shortages. Tzu Chi volunteers first organized relief distributions and free clinics in 1998. When volunteers held a free clinic in Kota Marudu in 2003, they met the local medical staff including Dr. Zhen Rong-hui, Yakub, and other nurses.

Knowing the difficulties faced by local pregnant women, the volunteers decided to set up a home where pregnant women could stay until their time. Li Ji-zhuan (李濟專), a long-term volunteer responsible for free clinics, said, "The aboriginal villages are deep in the mountains, so their development is snail-paced. A home like this will be needed for the next 20 years."

Nevertheless, it wasn't easy to find a good location in Pitas for this home because there were few people and houses. After two months a local teacher was assigned to teach elsewhere, so the volunteers rented his house, which was about a five-minute drive away from a clinic, and turned it into a childbirth waiting home.

The home has two bedrooms with complete sets of beds, mattresses, and pillows for eight people. There is a TV, a radio, a drinking fountain, electric fans, lights and cabinets. There are two shower rooms downstairs, and one of them is also a washroom.

Li Ji-zhuan said that they also hired Lucy Chin, the owner of a grocery store next door, to provide three meals and afternoon tea every day to the pregnant women staying in the house. He hoped the mothers would feel comfortable and wouldn't have to do anything except wash their own clothes.

In April 2003, the childbirth waiting home was ready, and Rainah, a mother-to-be, came to stay on May 1. Volunteers Li Ji-zhuan, Ouyang Ji-yuan (歐陽濟緣) and Leong Wai Meng (梁慧敏) made a special trip from Kota Kinabalu to welcome her.

Rainah came from Kampong Maidan to have her sixth child. Her last two pregnancies had ended in miscarriages. A nurse determined her to be in the high-risk group, and she told her that she could stay for free at the Tzu Chi home. Shortly afterwards, Rainah had a safe delivery in a nearby clinic. She rested for three weeks before heading home with her baby.

With this wonderful beginning, the childbirth waiting home, dubbed "House of Compassion," was officially opened in July 2003. Its name spread out among the villages, and many pregnant women decided to stay there.

Jamilah Makijam, Rainah's niece, witnessed her own mother's death from loss of blood during childbirth and an unsuccessful attempt to send her to the hospital. Therefore, she decided to come to the House of Compassion for her own childbirth. Makijam recalled her mother's tragic event: "Mom was due to give birth during the rainy season in December. It had been raining for days and there was no car or boat to take my mom to the hospital. We couldn't even find a midwife."

The inconvenient transportation was a problem that the mountain people could not solve easily. Therefore, Tzu Chi volunteers followed the medical staff to the mountains to bring high-risk pregnant women down to the city. Downik Gayandui from Kampong Kandang was an example.

We went to Kampong Kandang and saw many long wooden houses. In one of them, which was so dark inside that you couldn't see the end of the corridor, lived ten families. When we arrived, Gayandui had just come back from the fields with a traditional bamboo basket on her back. She smiled when she saw us.

Gayandui, another of Rainah's nieces, suffered from serious anemia. When she was pregnant, her hemoglobin was less than half the normal amount. She had already had one miscarriage, so she belonged to the high-risk group. The volunteers and medical personnel spent more than four hours on the road to take her down to a major hospital in Kota Kinabalu for a blood transfusion and better care. One week later, she gave birth to her eighth child. After receiving medical advice, she also underwent tubal ligation surgery.

"You appeared when I was in danger!" Holding her sleeping son, Gayandui said with tears in her eyes, "It's really terrible with so many children, but I won't suffer anymore."

Li Ji-zhuan said, "Whout these caring medical people and Tzu Chi's House of Compassion, this mother and little baby wouldn't be here before us."

The rainy season in Sabah comes in November and December. A sudden downpour in Pitas made the city look blurry through the mist and raindrops.

While visiting the town, we stayed in the House of Compassion for a few days. Seeing the rain outside the window, I believed that this small house presented a sense of ease and warmth in comparison to the aborigines* houses, which had no running water or electricity.

The medical staff stationed in Pitas told us that the House of Compassion has reduced the mortality rate of pregnant women in Pitas to zero. They felt proud as the government would not question their medical standards anymore.

Dr. Jennifer John Kidi said, "Pitas is so far away from any major city. The House of Compassion shortens the distance between the pregnant women and the clinic, and it's a great help."

The nurses have been spreading the news about the House of Compassion among the people in the villages, so the home has become famous in places as far as Paitan in Sandakan. Just like Li Ji-zhuan said, "It is a home to save lives and a place to stay comfortably."

Watching the torrential rain outside the window, we realized that the lives of many pregnant women in Pitas would be properly sheltered by this house from now on.


 

The Beauty of the Jing Si Abode

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